Hypertension and Heart Failure

Question 1

Essential (primary) type I hypertension

Answer 1

Benign. Most common, slow progression, asymptomatic. Leads to CAD, cardiac failure, CVAs, renal failure, and peripheral vascular disease.

Question 2

Essential (primary) type II hypertension

Answer 2

Malignant. Quickly induces heart failure, edema, and cerebral/renal damage.

Question 3

What are the 7 types of secondary hypertension?

Answer 3

Renal artery stenosis, renal disease, Conn’s syndrome, pheochromocytoma, pre-eclampsia toxemia, hyperthyroidism, Cushing’s disease

Question 4

Which is more prevalent, primary or secondary hypertension?

Answer 4

Primary (90-95%)

Question 5

Which organ is involved in the maintenance of chronic hypertension?

Answer 5

kidneys

Question 6

What is the primary pathology of primary hypertension?

Answer 6

Increase in TPR, increase in CO, and/or, increase in blood volume

Question 7

Pump-based Hypertension

Answer 7

Increase in CO. Occurs in younger patients, amenable to beta blockers

Question 8

Vascular Resistance-based Hypertension

Answer 8

Increase in TPR. Smooth muscle is abnormally sensitive to vasoconstrictors. Seen in older patients.

Question 9

Volume-based Hypertension

Answer 9

Increase in retentions of sodium and water. Renal parenchyma disease, renovascular disorders. Failure of the RAS to regulate BP

Question 10

Why is blood volume increased in HPT?

Answer 10

you need a higher arterial pressure to excrete sodium and water, requiring a higher blood volume

Question 11

Baroreceptors

Answer 11

Baroreceptors modulate moment to moment changes in BP, and are not involved in long term regulation.

Question 12

Peripheral vasodilators

Answer 12

decrease TPR

Question 13

Diuretics

Answer 13

Decrease ECF and therefore BP

Question 14

ACE Inhibitors

Answer 14

Decrease angiotensin II, and decrease vascular tone and ECF volume

Question 15

B adrengeric blockers

Answer 15

Decrease CO and therefore BP

Question 16

Syncope

Answer 16

Sudden and transient loss of consciousness due to a fall in BP, resulting in reduced cerebral perfusion

Question 17

Postural Hypertensions

Answer 17

Physiologic peripheral vasoconstriction on standing in impaired resulting in hypotension

Question 18

Cardiac Syncope

Answer 18

mechanical cardiac dysfunction or arrhythmia

Question 19

Neurocardiogenic Syncope

Answer 19

Abnormal autonomic reflex causes bradycardia and/or hypotension

Question 20

What are the clinical features of congestive cardiac failure?

Answer 20

Exercise intolerance, breathlessness (dyspnea), fatigue, peripheral edema

Question 21

What type of failure is heart failure?

Answer 21

Left ventricular failure, which can lead to right ventricular failure

Question 22

What are the three factors that affect stroke volume?

Answer 22

Contractility, preload, after load

Question 23

What happens in systolic failure?

Answer 23

Decrease in contractility leading to a decrease in stroke volume (starling curve shifts down and to the right)

Question 24

What happens in diastolic failure?

Answer 24

failure in filling (mitral stenosis) which leads to decreased EDV and decreased SV

Question 25

Heart Failure with Reduced Ejection Fraction

Answer 25

Mostly systolic failure

Question 26

Heart Failure with Preserved Ejection Fraction

Answer 26

Mostly diastolic failure

Question 27

What kind of edema results from LV failure?

Answer 27

Pulmonary edema

Question 28

What kind of edema results from RV failure?

Answer 28

Peripheral edema

Question 29

Where are baroreceptors found?

Answer 29

Carotid and aortic arch